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Testosterone therapy

Your doctor may have talked to you about whether testosterone therapy is right for you. Here’s some information about testosterone therapy; what it does; the benefits, risks, and side-effects; and how to take it.

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What is testosterone therapy?

Loss of sexual desire (libido) can be caused by many different medical and psychological conditions. Low levels of the class of hormones called androgens may be one of the factors leading to your loss of libido. As testosterone is an androgen, testosterone therapy may be offered to help boost your libido. Other support may also be recommended, such as treating any vaginal symptoms and psychosexual or relationship counseling.

Testosterone is made in your ovaries and your adrenal glands, which are small glands near your kidneys. Levels of testosterone in your body gradually reduce as you become older, and they reduce very abruptly in women who have had an oophorectomy (an operation in which their ovaries are removed). When women’s testosterone levels decrease, some may find that they desire sex less often, and when they do have sex, it’s not as pleasurable as it used to be, even though they still desire their partner.  For many women, the lower testosterone level has no impact on libido whatsoever. The primary reason for replacing testosterone is to help improve libido. Although some women have reported that testosterone may also improve energy levels, well-being, cognitive function, and joint pains, there is no evidence to date to support these benefits. This is an area where more studies are needed.

What are the benefits of testosterone therapy?

Replacing testosterone can increase your sexual desire and pleasure.

Are there any risks to testosterone therapy?

Studies to date suggest that there’s no increased risk of heart disease, breast cancer, or stroke in the short term, but we don’t have studies that tell us about the long-term risks and safety of testosterone therapy.

Testosterone should not be taken if you are pregnant, if you could be pregnant or if you are at risk of pregnancy. This is because testosterone could affect the baby’s development. If you are unsure if this applies to you, please discuss this with your doctor or other healthcare professional. See here for more information on fertility and contraception needs in the menopause transition.

What are the side effects of testosterone therapy?

The most common side effects are skin changes, such as acne, increased greasiness of the hair, and thicker body hair.

Androgenic side effects include acne and, rarely, virilisation (voice deepening and an enlarged clitoris).

Other rare side effects include hair loss, excessive hairiness, fluid retention, increase in muscle mass, weight gain, nausea, headaches, mood changes, jaundice, and an increase in cholesterol.

Side effects are generally only seen when high doses of testosterone ar given. Hirsutism (excess hair) and acne are usually mild and depend on the dose of testosterone you’re taking. Reducing the dose may help, or else stopping treatment altogether.

For more information:

How to take testosterone therapy

In the past, testosterone has been given by different routes, including patches, which were withdrawn for commercial reasons, and implants that are available in some private clinics (but not ours). Testosterone gel is available in the UK on NHS or private prescriptions, or cream, which is only available privately.

In the UK, testosterone isn’t licensed for use in women, only men, but is often prescribed off-licence for women. Its use is endorsed by the National Institute of Clinical Excellence Guidelines on the menopause NG 23 2015.

(You can read more about prescribing testosterone off-licence here)

Testosterone is applied to the skin as a gel or cream so that it goes directly into your bloodstream. The doses used in women are much lower than those used for men. The aim is to keep the testosterone at a level that’s not greater than those found in premenopausal women. It may take 3-6 months to feel any benefit from taking testosterone. If there has been no benefit in that time, we would advise you to stop using it.

Risk of testosterone transfer to others

During close and relatively long periods of skin contact testosterone may be transferred to another person unless you cover the treated area. Transfer can potentially result in the other person showing signs of increased testosterone – masculinisation effects as described in the side effects above. Wearing clothes covering the application area or washing the application area before contact protects against such transfer. The following precautions are recommended:

For the patient:

  • wash your hands with soap and water after applying the gel
  • cover the application area with clothing once the gel has dried
  • wash the application area before making close contact with another person

If you believe testosterone has been transferred to another person (man, woman, or child), this person should:

  • wash the area of skin onto which may have been affected immediately with soap and water
  • report any signs such as acne or changes in the growth or pattern of hair on the body or face to their doctor

You should preferably wait at least 1 hour before showering or bathing after applying the testosterone gel.

Available testosterone

The different types of testosterone available off-licence in the UK and how to use them are outlined below.

Androfemme (Lawley Pharm)

1% testosterone cream in 50ml tube. Starting dose is 0.5mls per day (5mg testosterone a day). Only available privately, the cost of a 50g tube is around £93, and this will last approximately 100 days.

Testim Gel (Endo Ventures Ltd)

50mg testosterone per 5g tube (1%). Use a small, pea-sized amount (approx. 0.5g gel = 5mg testosterone) and rub it into the front of the thigh daily. One tube should last around 14 days.

Testogel (Besins Healthcare Ltd UK)

  • 50mg per 5g sachet (1%). Use a small, pea-sized amount and rub it into the front of the thigh daily. The sachet should last around 14 days. You can fold over the open top and clip it with a bag clip. (CURRENTLY UNAVAILABLE)
  • 40.5mg per 2.5g sachet. Use a small, pea-sized amount and rub it into the front of the thigh daily. The sachet should last around 8 days. You can fold over the open top and clip it with a bag clip or equivalent.

Tostran Gel (Kyowa Kirin Ltd)

20mg in 1g. One press delivers 10mg of testosterone. Use 1 press of gel 2 to 3 times a week. If you use it every day, the dose will be too high.

Don’t apply the gel to the same patch of skin every time. Change the site of the application to avoid additional hair growth at application sites.

 

You can read more about HRT here, and this link takes you to the questions we most frequently get asked about HRT.

Authored by:

Dr Clare Spencer
Registered menopause specialist, GP and co-founder; see Dr Clare in person at The Spire Hospital, Leeds or online

Last updated:

15/05/2024

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